If the insurer disputes liability for your claim there is help available.
If the insurer decides to dispute liability for your workers compensation claim they will advise you of their reason(s) in writing (this is called a dispute notice) and provide information on the next steps available to you.
Examples of when disputes can happen include:
- the insurer does not consider the person making the claim to be a ‘worker’ (under the legislation)
- the insurer considers that employment was not a substantial contributing factor to the injury
- it was not 'reasonably necessary' to have the medical treatment or other claim-related expenses.
When disputes happen there is help available to have it resolved. Give us a call on 13 10 50 and we can also talk you through the process outlined below.
Request a review by the insurer
The first step is to contact the insurer and request they review the decision.
When you do this they will advise you of the procedure to request the review.
When requesting the review you should explain why you are requesting it and include any additional information you think is relevant to helpthe insurer review the decision.
It's very important you include all relevant information now because you may not be allowed to introduce new material if you later choose to lodge an application to resolve the dispute at the Workers Compensation Commission.
The insurer must respond to you in writing within 14 days of receiving the request for a review. The insurer will either decide to overturn or modify the original decision or maintain the decision.
If the insurer fails to attach all relevant documents or communicate everything they are required to, then the insurer must correct the dispute notice(s) as soon as they become aware.
You can contact the Workers Compensation Independent Review Office (WIRO) if you are dissatisfied at any stage during this process.
WIRO is an independent statutory office with a variety of roles, including helping find solutions to disputes by contacting the insurer on your behalf.
Where disputes cannot be resolved, they can help injured workers apply for legal aid through the Independent Legal Assistance and Review Service.
For more information on how WIRO can help:
Apply to the Workers Compensation Commission to resolve the dispute
If you do not wish to seek a review by the insurer or are not satisfied with the insurer's decision after a review, you can lodge an application to resolve the dispute at the Workers Compensation Commission (WCC).
The WCC is an independent tribunal that helps resolve workers compensation disputes between injured workers, employers and/or insurers.
The kind of disputes they resolve include:
- weekly payments and compensation
- medical, hospital and related expenses
- permanent impairment compensation
- compensation for death of a worker
- compensation for damage to personal property
- compensation for domestic assistance.
If you do apply to have the dispute resolved by the WCC, only the information included in the insurer’s original dispute notice and the documents you submitted for this initial insurer review will be considered (unless there are exceptional circumstances). That’s why it’s important for you to include all relevant information when you request an insurer review.
The process for resolving your dispute depends on the type of matter that is in dispute.
For most matters (eg where compensation, medical expenses or where liability is disputed) the WCC will appoint an arbitrator. Arbitrators are independent legal professionals experienced in the workers compensation system.
For more information you can visit their website or call 1300 368 040.